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Dental vs. medical insurance: Where do the two diverge?

Written by Mackenzie Garrity on May 29, 2018

Our industry is moving into more medical billing, just by the fact that dental has not increased their benefits and many services are no longer covered under dental.  Office managers contact me when they receive an eob telling them to bill medical.  How, do they do it, have they ever filled a medical claim out, what codes do they use.  Why do we wait until we have to do something?   Just get into the game now.

See what patients are looking at, and asking me for a list of dentists who understand how to bill medical.  We have started to refer to doctors who have team members that can and will do the work for patients in need.  See our list.

The ACA is designed to provide a greater access to healthcare, and in many ways, it does. However, there is still a large gap in the access to dental care and dental insurance.

While many employers offer dental insurance, often it does not cover major dental procedures. David Tuller, a 61-year old San Francisco resident, experienced the realities of dental insurance after undergoing major restorative surgery, according to CNN. Mr. Tuller worked at UC Berkeley, which capped dental coverage at $1,500. For many, this is an average dental insurance plan. However, for people similar to the Mr. Tuller dental insurance does not help with major restoration surgeries.

Mr. Tuller didn’t have bad oral hygiene. He used his dental insurance coverage to go to the dentist for preventative visits. However, when he turned 40 years old, Mr. Tuller developed an advanced case of periodontitis. He needed multiple extractions, titanium implants in his jaw, porcelain teeth for implants, bone grafts and various gum surgeries. Since his original diagnosis, Mr. Tuller has spent $55,000 in out-of-pocket costs while having dental insurance, according to CNN.

Countless Americans face the same fate as Mr. Tuller. A study reported by CNN showed in 2015 nearly 35 percent of American working adults did not have dental insurance. This compares to the only 12 percent of American adults who did not have medical insurance.

The lack of access to dental care has caused many patients to seek treatment in other countries or go without. For this reason, dental care and treatment are seen as luxuries rather than necessity. However, an increasing amount of research highlights the relationship between dental care and overall health. Periodontitis is among the dental conditions linked to cause other health complications.

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